scholarly journals Comparison of Simple Stylet versus Lighted Stylet for Intubating the Trachea with a Direct Laryngoscope: A Randomized Clinical Trial

2019 ◽  
Vol 8 (2) ◽  
pp. 140
Author(s):  
Seongjoo Park ◽  
Jeongpyo Hong ◽  
Jin-Woo Park ◽  
Sung-Hee Han ◽  
Jin-Hee Kim
Keyword(s):  
Tracheal Intubation ◽  
Success Rate ◽  
Sore Throat ◽  
Direct Laryngoscopy ◽  
Intubation Time ◽  
Postoperative Sore Throat ◽  
Suprasternal Notch ◽  
Direct Laryngoscope ◽  
Mucosal Bleeding ◽  
Lighted Stylet

This study investigated the effectiveness of a lighted stylet during tracheal intubation with direct laryngoscopy. The study randomly assigned 284 patients undergoing general anesthesia to either the simple stylet (Group S) or lighted stylet (Group L) groups. In both groups, stylet-assisted intubation was performed with direct laryngoscopy. In group S, a simple stylet was used and removed when the tip of the endotracheal tube was thought to have passed the larynx. In Group L, a lighted stylet was used and removed after confirming transillumination of the suprasternal notch. The success rate at the first attempt, total intubation time, incidence of mucosal bleeding, and severity of postoperative sore throat were compared. Compared to a simple stylet, the lighted stylet significantly increased the success rate of tracheal intubation at the first attempt (128 (90%) vs. 140 (99%), p = 0.003, Groups S and L, respectively). The incidence of mucosal bleeding was significantly higher in Group S (35 (25%) vs. 19 (13%), p = 0.011, Groups S and L, respectively). The total intubation time and degree of postoperative sore throat were not significantly different between the two groups. A lighted stylet increased the success rate of tracheal intubation during stylet-assisted tracheal intubation with direct laryngoscopy.

Clinical Assessment of a Plastic Optical Fiber Stylet for Human Tracheal Intubation 

1999 ◽  
Vol 91 (3) ◽  
pp. 648-648 ◽  
Author(s):  
Dietrich Gravenstein ◽  
Richard J. Melker ◽  
Samsun Lampotang
Keyword(s):  
Tracheal Intubation ◽  
Sore Throat ◽  
Direct Laryngoscopy ◽  
Fiberoptic Bronchoscopy ◽  
Postoperative Sore Throat ◽  
Laryngeal View ◽  
Course Characteristics ◽  
Severity Grade ◽  
Novice Users

Background The authors compared the performance of a prototype intubation aid that incorporated plastic illumination and image guides into a stylet with fiberoptic bronchoscopy and direct laryngoscopy for tracheal intubation by novice users. Methods In a randomized, nonblinded design, patients were assigned to direct laryngoscopy, fiberoptic bronchoscopy, or imaging stylet intubation groups. The quality of laryngeal view and ease with which it was attained for each intubation was graded by the laryngoscopist. Time to intubation was measured in 1-min increments. A sore-throat severity grade was obtained after operation. Results There were no differences in demographic, physical examination, or surgical course characteristics among the groups. The laryngoscope produced an adequate laryngeal view more easily than did the imaging stylet or bronchoscope (P = 0.001) but caused the highest incidence of postoperative sore throat (P<0.05). Although the time to intubation for direct laryngoscopy was shorter than for imaging stylet, which was shorter than fiberoptic bronchoscopy (P<0.05), the quality of laryngeal view with the imaging stylet was inferior to both direct laryngoscopy and fiberoptic bronchoscopy techniques (P<0.05). Conclusions Novices using the imaging stylet produce fewer cases of sore throat (compared with direct laryngoscopy) and can intubate faster than when using a bronchoscope in anesthetized adult patients. The imaging stylet may be a useful aid for tracheal intubation, especially for those unable to maintain skills with a bronchoscope.

scholarly journals Comparison of Direct and Indirect Laryngoscopes in Vomitus and Hematemesis Settings: A Randomized Simulation Trial

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Ryosuke Mihara ◽  
Nobuyasu Komasawa ◽  
Sayuri Matsunami ◽  
Toshiaki Minami
Keyword(s):  
Tracheal Intubation ◽  
Success Rate ◽  
Macintosh Laryngoscope ◽  
Intubation Time ◽  
Direct Laryngoscope ◽  
Mcgrath Mac ◽  
Significant Difference ◽  
Intubation Success ◽  
Intubation Success Rate

Background.Videolaryngoscopes may not be useful in the presence of hematemesis or vomitus. We compared the utility of the Macintosh laryngoscope (McL), which is a direct laryngoscope, with that of the Pentax-AWS Airwayscope (AWS) and McGRATH MAC (McGRATH), which are videolaryngoscopes, in simulated hematemesis and vomitus settings.Methods.Seventeen anesthesiologists with more than 1 year of experience performed tracheal intubation on an adult manikin using McL, AWS, and McGRATH under normal, hematemesis, and vomitus simulations.Results.In the normal setting, the intubation success rate was 100% for all three laryngoscopes. In the hematemesis settings, the intubation success rate differed significantly among the three laryngoscopes (P=0.021). In the vomitus settings, all participants succeeded in tracheal intubation with McL or McGRATH, while five failed in the AWS trial with significant difference (P=0.003). The intubation time did not significantly differ in normal settings, while it was significantly longer in the AWS trial compared to McL or McGRATH trial in the hematemesis or vomitus settings (P<0.001, compared to McL or McGRATH in both settings).Conclusion.The performance of McGRATH and McL can be superior to that of AWS for tracheal intubation in vomitus and hematemesis settings in adults.

Retrograde Light-guided Laryngoscopy for Tracheal Intubation

2013 ◽  
Vol 118 (5) ◽  
pp. 1059-1064 ◽  
Author(s):  
Tao Yang ◽  
Jiong Hou ◽  
Jinbao Li ◽  
Xu Zhang ◽  
Xiaoyan Zhu ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Success Rate ◽  
Visual Analog Scale ◽  
Direct Laryngoscopy ◽  
Primary Outcome ◽  
Intubation Time ◽  
Analog Scale ◽  
Open Label ◽  
Intubation Technique ◽  
Rate Difference

Abstract Background: Tracheal intubation with conventional laryngoscopy requires many trials until beginners are sufficiently skilled in intubating patients safely. To facilitate intubation, the authors used retrograde light-guided laryngoscopy (RLGL) and compared its feasibility with conventional direct laryngoscopy (DL). Methods: Twenty operators participated in a prospective, randomized, open-label, parallel-arm study. These operators intubated 205 patients randomly according to a computer-generated procedure by using either DL or RLGL (five intubations with each technique). The primary outcome was the success rate of tracheal intubation. The authors evaluated the success rate of tracheal intubation, the time to glottic exposure and tracheal intubation, and the Cormack and Lehane grades. Results: Compared with DL, the success rate was greater in the RLGL group for all five intubations (72% vs. 47%; rate difference, 25%; 95% CI [11.84–38.16%], P &lt; 0.001). This was associated with a shorter time to glottic exposure (median [25th and 75th percentile]; 27 [15; 42] vs. 45 [30; 73] s, P &lt; 0.001), shorter intubation time (66 [44; 120] vs. 120 [69; 120] s, P &lt; 0.001), and decreased throat soreness (mean ± SD; visual analog scale, 2.1 ± 0.9 vs. 3.7 ± 1.0 cm, P = 0.001) in the RLGL group compared to the DL group. Conclusion: RLGL is an alternative intubation technique. In our study, it enables beginners to intubate patients more successfully and quickly than conventional DL.

Success of Intubation Rescue Techniques after Failed Direct Laryngoscopy in Adults

2016 ◽  
Vol 125 (4) ◽  
pp. 656-666 ◽  
Author(s):  
Michael F. Aziz ◽  
Ansgar M. Brambrink ◽  
David W. Healy ◽  
Amy Wen Willett ◽  
Amy Shanks ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Success Rate ◽  
Direct Laryngoscopy ◽  
Video Laryngoscopy ◽  
Perioperative Outcomes ◽  
Supraglottic Airway ◽  
Fiberoptic Intubation ◽  
Success Rates ◽  
Intubation Success Rate ◽  
Lighted Stylet

Abstract Background Multiple attempts at tracheal intubation are associated with mortality, and successful rescue requires a structured plan. However, there remains a paucity of data to guide the choice of intubation rescue technique after failed initial direct laryngoscopy. The authors studied a large perioperative database to determine success rates for commonly used intubation rescue techniques. Methods Using a retrospective, observational, comparative design, the authors analyzed records from seven academic centers within the Multicenter Perioperative Outcomes Group between 2004 and 2013. The primary outcome was the comparative success rate for five commonly used techniques to achieve successful tracheal intubation after failed direct laryngoscopy: (1) video laryngoscopy, (2) flexible fiberoptic intubation, (3) supraglottic airway as part of an exchange technique, (4) optical stylet, and (5) lighted stylet. Results A total of 346,861 cases were identified that involved attempted tracheal intubation. A total of 1,009 anesthesia providers managed 1,427 cases of failed direct laryngoscopy followed by subsequent intubation attempts (n = 1,619) that employed one of the five studied intubation rescue techniques. The use of video laryngoscopy resulted in a significantly higher success rate (92%; 95% CI, 90 to 93) than other techniques: supraglottic airway conduit (78%; 95% CI, 68 to 86), flexible bronchoscopic intubation (78%; 95% CI, 71 to 83), lighted stylet (77%; 95% CI, 69 to 83), and optical stylet (67%; 95% CI, 35 to 88). Providers most frequently choose video laryngoscopy (predominantly GlideScope® [Verathon, USA]) to rescue failed direct laryngoscopy (1,122/1,619; 69%), and its use has increased during the study period. Conclusions Video laryngoscopy is associated with a high rescue intubation success rate and is more commonly used than other rescue techniques.

Clinical Trial of a New Lightwand Device (Trachlight) to Intubate the Trachea

1995 ◽  
Vol 83 (3) ◽  
pp. 509-514. ◽  
Author(s):  
Orlando R. Hung ◽  
Saul Pytka ◽  
Ian Morris ◽  
Michael Murphy ◽  
Gordon Launcelott ◽  
...  
Keyword(s):  
Sore Throat ◽  
Failure Rate ◽  
Direct Laryngoscopy ◽  
Upper Airway ◽  
Surgical Patients ◽  
Successful Intubation ◽  
Dental Injury ◽  
Mucosal Bleeding ◽  
Lighted Stylet ◽  
Mandibular Protrusion

Background Transillumination of the soft tissue of the neck using a lighted stylet (lightwand) is an effective and safe intubating technique. A newly designed lightwand (Trachlight) incorporates modifications to improve the brightness of the light source as well as flexibility. The goal of this study was to determine the effectiveness and safety of this device in intubating the trachea of elective surgical patients. Methods Healthy surgical patients were studied. Patients with known or potential problems with intubation were excluded. During general anesthesia, the tracheas were intubated randomly using either the Trachlight or the laryngoscope. Failure to intubate was defined as lack of successful intubation after three attempts. The duration of each attempt was recorded as the time from insertion of the device into the oropharynx to the time of its removal. The total time to intubation (TTI), an overall measure of the ease of intubation, was defined as the sum of the durations of all (as many as three) intubation attempts. Complications, such as mucosal bleeding, lacerations, dental injury, and sore throat, were recorded. Results Nine hundred fifty patients (479 in the Trachlight group and 471 in the laryngoscope group) were studied. There was a 1% failure rate with the Trachlight, and 92% of intubations were successful on the first attempt, compared with a 3% failure rate and an 89% success rate on the first attempt with the laryngoscope (P not significant). All failures were followed by successful intubation using the alternate device. The TTI was significantly less with the Trachlight compared with the laryngoscope (15.7 +/- 10.8 vs. 19.6 +/- 23.7 s). For laryngoscopic intubation, the TTI was longer for patients with limited mandibular protrusion and mentohyoid distance, with a larger circumference of the neck, and with a high classification according to Mallampatti et al. However, there was no relation between the TTI and any of the airway parameters for Trachlight. There were significantly fewer traumatic events in the Trachlight group than in the laryngoscope group (10 vs. 37). More patients complained of sore throat in the laryngoscope group than in the Trachlight group (25.3% vs. 17.1%). Conclusions In contrast to laryngoscopy, the ease of intubation using the Trachlight does not appear to be influenced by anatomic variations of the upper airway. Intubation occasionally failed with the Trachlight but in all cases was resolved with direct laryngoscopy. The failures of direct laryngoscopy were resolved with Trachlight. Thus the combined technique was 100% successful in intubating the tracheas of all patients.

A COMPARISON OF EFFECT OF NEBULISED KETAMINE AND NEBULISED MAGNESIUM SULPHATE IN REDUCTION OF INCIDENCE AND SEVERITY OF POSTOPERATIVE SORE THROAT - A PROSPECTIVE RANDOMIZED DOUBLE BLINDED STUDY

2021 ◽  
pp. 38-40
Author(s):  
M. Selvi Annie Geeta ◽  
M. Ramesh Ram
Keyword(s):  
Tracheal Intubation ◽  
General Anesthesia ◽  
Sore Throat ◽  
Magnesium Sulphate ◽  
Success Rates ◽  
Postoperative Sore Throat ◽  
It Effectiveness ◽  
Duration Of Surgery ◽  
The Mean ◽  
Group B

Introduction: Postoperative sore throat (POST) is a common occurrence following general anesthesia with endotracheal intubation. The incidence of POST is estimated to be 21%-65% in various studies. Irritation and inammation of the air way are considered to be the cause of POST. Although considered a minor and self limiting complication, it may cause a signicant patient morbidity, dissatisfaction and increased the length of duration of hospital stay. Various pharmacological and non pharmacological methods have been tried to decrease POST with varying success rates. Among the interventions, the use of ketamine gargle or lozenges has highest success rates, but the problem with this is the bitter taste of the drug and the risk of aspiration, so aerosol route of drug administration gained popularity among the anesthesiologists with good acceptance from the patients. It is known that N-methyl-D-aspartate (NMDA) receptors have a role in nociception and inammation. Hence, this study is aimed at using the aerosol route of magnesium sulphate and ketamine and to nd it effectiveness in preventing POST. Aim Of The Study: To evaluate the effect of nebulized ketamine and nebulized magnesium sulphate for attenuation of postoperative sore throat in patients undergoing surgeries under general anesthesia with tracheal intubation. Materials And Methods: This study was done in the Department of Anesthesiology in collaboration with the Department of Surgery in Kanyakumari Government Medical College from January 2019 to December 2019. Patient planned for surgery under general anesthesia except head, neck & ENT surgeries were selected and randomized into two groups (35 each). Each group received nebulisation for 15 min before induction of general anaesthesia. Group M: Nebulization with 500mg magnesium sulphate in 5ml NS. Group K: Nebulization with 50mg ketamine in 5ml NS. The Parameters related to the study such as duration of laryngoscopy, time taken to intubate, duration of surgery, number of attempts to intubate were recorded. Incidence and severity of sore throat were assessed by four point scale. Incidence of sore throat is assessed for 24 hours. Complication were recorded. Results: We found that the demographic parameters were comparable and statistically insignicant. The mean duration of laryngoscopy difference between the two groups Group M - 24.54± 1.12 seconds and Group K - 24.49 ±1.15 seconds was not statistically signicant P= 0.834 (P>0.05). The mean time taken to intubate in Group M - 27.54± 1.12 seconds and Group K - 27.54± 1.12 seconds was not statistically signicant with P=1.000 respectively (P>0.05). The mean duration of surgery in Group M - 90.71±15.67 minutes and the Group K - 88.20 ±16.53 minutes between the two groups was not statistically signicant P= 0.516 (P>0.05). The mean difference of number of attempts taken to intubate between the two groups was statistically insignicant P=0.771 (P>0.05). The overall incidence of sore throat in Group M was 91% and in Group B was 34%. The severity of sore throat between Group M and Group K is statistically signicant at 2, 4, 6 hrs at grade 1 and grade 2. Conclusion: On the basis of our result, we can suggest that the use of perioperative ketamine nebulization when compared magnesium sulphate nebulization reduces the incidence and severity of post-operative sore throat at 4th and 6th hour during postoperative period in patients who had received general anesthesia with tracheal intubation.

scholarly journals Comparison between use of single lightwand and video laryngoscope-guided lightwand for tracheal intubation in simulated cervical spine-immobilized patients: a single-blind randomized study

2019 ◽  
Vol 47 (11) ◽  
pp. 5632-5642
Author(s):  
Ha Yeon Kim ◽  
Eun Jung Kim ◽  
Hei Jin Yoon ◽  
Byungwoong Ko ◽  
Seung Yeon Choi ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Postoperative Complications ◽  
Tracheal Intubation ◽  
Success Rate ◽  
Randomized Study ◽  
Video Laryngoscope ◽  
Second Grade ◽  
Airway Complications ◽  
Mucosal Bleeding ◽  
Single Blind

Objective This study was performed to compare the use of a video laryngoscope-guided lightwand versus a single lightwand for tracheal intubation performed by non-experts in cervical spine-immobilized patients. Methods In total, 318 patients under general anesthesia were assigned either to the single lightwand group (Group L) or the video laryngoscope-guided lightwand group (Group VL) at a 1:1 ratio. First- or second-grade residents performed tracheal intubation with the assigned device after applying semi-hard fitted cervical collars to the patients. Outcomes, including the success rate and airway complications, were compared between the two groups. Results There were no significant differences in demographics or airway-related characteristics between the two groups. The success rate of intubation on the first attempt was significantly higher in Group VL than in Group L (90% vs. 64%, respectively). Postoperative complications, including oral mucosal bleeding, hoarseness, and sore throat scores at 1 and 24 hours after surgery, were significantly lower in Group VL than in Group L. Conclusions The use of a video laryngoscope-guided lightwand for tracheal intubation can be useful for non-experts who encounter difficult airway situations.

scholarly journals First attempt success of video versus direct laryngoscopy for endotracheal intubation by ambulance nurses: a prospective observational study

2020 ◽  
Vol 46 (5) ◽  
pp. 1039-1045 ◽  
Author(s):  
Wim Breeman ◽  
Mark G. Van Vledder ◽  
Michael H. J. Verhofstad ◽  
Albert Visser ◽  
Esther M. M. Van Lieshout
Keyword(s):  
Success Rate ◽  
Endotracheal Intubation ◽  
Direct Laryngoscopy ◽  
Prospective Observational Study ◽  
Primary Outcome ◽  
Spontaneous Circulation ◽  
Video Laryngoscope ◽  
Video Laryngoscopy ◽  
Direct Laryngoscope ◽  
Positive Effect

Abstract Purpose The aim of this study was to compare the rate of first attempt success of endotracheal intubation performed by ambulance nurses in patients with a Glasgow Coma Scale (GCS)  of 3 using video laryngoscopy versus direct laryngoscopy. Methods A prospective cohort study was conducted in a single, independent ambulance service. Twenty of a total of 65 nurse-staffed ambulances were equipped with a video laryngoscope; a classic direct laryngoscope (Macintosh) was available on all 65 ambulances. The primary outcome was first attempt success of the intubation. Secondary outcomes were overall success, time needed for intubation, adverse events, technical or environmental issues encountered, and return of spontaneous circulation (ROSC). Ambulance nurses were asked if the intubation device had affected the outcome of the intubation. Results The first attempt success rate in the video laryngoscopy group [53 of 93 attempts (57%)] did not differ from that in the direct laryngoscopy group [61 of 126 (48%); p = 0.221]. However, the second attempt success rate was higher in the video laryngoscopy group [77/93 (83%) versus 80/126 (63%), p = 0.002]. The median time needed for the intubation (53 versus 56 s) was similar in both groups. Ambulance nurses more often expected a positive effect when performing endotracheal intubation with a video laryngoscope (n = 72, 81%) compared with a direct laryngoscope (n = 49, 52%; p < 0.001). Conclusion Although no significant effect on the first attempt success was found, video laryngoscopy did increase the overall success rate. Ambulance nurses had a more positive valuation of the video laryngoscope with respect to success chances.

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